喀麦隆健康公平诊断，2025年11月（英）

SUMMARY REPORTPublic Disclosure Authorized CONTENTS Background 3 Methods5 Results5 High Level Summary of Key FindingsSystem Performance GoalsHealth StatusFinancial Risk ProtectionIntermediate Performance ObjectivesInequities in Service CoverageInequities in Access5779111213 Conclusions and Policy Implications Proposed Policy Design ConsiderationsFinancingPaymentOrganizationRegulationPersuasion Annex 1 Interpreting Trends in Health Outcomes and Inequality 18 20 Annex 2 Table 1. Health OutcomesTable 2. Service CoverageTable 3. Health Outcomes Regional DecompositionTable 4. Service Coverage Regional Decomposition20202121 BACKGROUND Cameroon has made significant progress towards achieving Universal Health Coverage(UHC) in recent decades, however, significant opportunities for improvement remain.Between 2000 and 2021, the country’s UHC Service Coverage Index doubled from 22to 441. Yet Cameroon lags behind the average for low- and middle-income countries (58)and falls far short of the global average (68). Aggregate measures like the UHC ServiceCoverage Index tend to mask inequities in who benefits from health improvements andwho bears the financial burden for the use of services. To make meaningful progress towardUHC, countries must unpack disparities in access, service coverage, quality of care, andfinancial protection and design policies that provide protection to the most vulnerable. In a fiscally constrained environment like Cameroon, equity must remain a key policyimperative.With higher global borrowing costs, additional constraints on external funding,a downturn in global demand, and a steep increase in economic uncertainty, fiscal spacefor the health sector remains a challenge. Against this backdrop, cost-effectiveness islikely to guide the prioritization of health investments and services, which can often beat odds with more costly approaches that prioritize the most vulnerable. Yet, addressinginequities in health outcomes, service quality, access, and financial protection is criticalto accelerating progress towards UHC, which represents a foundational investment inhuman capital. Inequalities in access to and quality of health services are deeply rootedand persist across socioeconomic, geographic, and demographic lines, including inCameroon, reflecting a system where the care you receive often depends on where youlive and what you can afford to pay. For example, coverage of Reproductive, Maternal,Newborn, Child and Adolescent Health and Nutrition (RMNCHA-N) services tend to behigher among those who are richer, better educated, and living in urban areas. As part of the broader Cameroon Health System Status Report (2025), the WorldBank has conducted a Country Equity Diagnostic (CED) – a systematic analysis ofhealth-related inequalities in Cameroon.The broaderHealth System Status Reportapplies the Control Knobs framework2(Figure 1, next page), which identifies five policylevers that influence health system performance across three intermediate objectives– efficiency, quality, and access. These, in turn, affect three overarching systemperformance goals: health status, public satisfaction, and financial risk protection.Building on this framework, outputs from the CED provide a more nuanced explorationof equity-related issues with a focus on the following dimensions: i) health status, ii)efficiency, particularly looking at the effective coverage of quality health services, iii)access (including foregone care), and iv) financial risk protection. Limited availability ofdata on quality and public satisfaction hindered a comprehensive assessment of equityfor those dimensions. The findings in this summary report and in theCameroon HealthSystem Status Reportare intendedto guide policymakers, donors, and stakeholderstoward reforms that leave no individual behind. METHODS This CED uses data from the 2014 and 2021 Cameroon Household Surveys (ECAM-IV andECAM-V) as well as the 2011 and 2018 Demographic and Health Surveys (DHS). Healthstatus data is calculated from the DHS and focuses on RMNCHA-N outcomes throughmean outcomes and concentration indices (CI). Annex 1 presents the definition of the CIand offers guidance for its interpretation. Financial risk protection estimates are calculatedbased on data from the ECAM-V and include analysis of types and distribution of individualhealth spending. This includes, for example, the distribution of individual spending onoutpatient, inpatient, and preventative care across varying socioeconomic factors. RESULTS High Level Summary of Key Findings: 1.Improvements in health have been largely pro-poor between 2011 and 2018. Therehas been significant progress in both health status and service coverage, with theimprovements largely driven by the most economically disadvantaged populations. 2.The poorest populations, however, still lag in service coverage for particularservices.For example, immunization coverage, and in particular children who havenot received any